the triple “A” in BANGS

14

Assess & Accept

 

When confronted with stressful situations, our first reaction is often that: a reaction. We act quickly without thinking because we want to normalize things in a hurry.

We usually also expect others to take responsibility for their own actions, and we’re accustomed to voicing our opinion on what’s happened. None of this works very well when dealing with dementia.

BANGS is mnemonic for five ways anyone can use to avert and defuse conflict with people who have Alzheimer’s dementia. Here are all links to all the letters in the mnemonic:

“B” is for breathe.

“A” is for assess, accept, and agree.

“N” is for never, never argue

“G” is for go with their flow, let go of your ego, get over it, get on with it, get down to it

“S”  is for say you’re sorry (again, and again, and again!)

This post is about the “A” in BANGS.

“A” is for Assess

Imagine this scenario:

A daughter comes back from an early morning run. It’s important for her to build in time for herself as she cares for her mother with dementia.  When she opens the door to her mother’s home, which she lives now too,  she’s assailed by a disgusting smell.

“Are you okay Mom?  she calls to her mother upstairs. No answer. As she climbs the stairs, the stench worsens. When she reaches the top, it is overwhelming. Diarrhea covers the long throw carpet in the hallway. She steps around patches of it on my way to her mother’s room where she finds her sitting on the bed.

“Hi Mom,” she says calmly as she walks over to her. “Is everything okay?”

“I just got up,” her mother says.

“Oh.” The daughter peeks into the ensuite. Shitty footprints all over the tiled floor. The smell makes her gag.

“Are you okay Mom? Did anything happen?”

“I don’t know. I don’t think so.”

“Okay Mom, can you stay here for a minute? I’ll be right back.”

“Okay.” The daughter walks out of the bedroom and back into the hall, rolls up the carpet poop and all and puts it at the top of the stairs.Thank God for easy-to-clean hardwood floors, she thinks to herself. She makes a right at the end of the hall and then a left into the main bathroom. Her hand flies up to cover her nose and mouth and to stop her from vomiting. There’s shit everywhere.

Who knows why her mother ventured down the hall and around two corners when there was a toilet less than six feet from her bed? But she did. When her bowels began evacuating, she probably panicked. She didn’t know what to do. She couldn’t find the commode. Compassion floods through the daughter. My poor mom. She shuts the door and goes back to her mother’s bedroom where she finds her mom sitting on the edge of the bed where she had left her.

“Hey Mom, are you hungry? Let’s go and make some breakfast.” The daughter helps her mom get showered and dressed and then takes her down to the kitchen. She makes toast and tea and while her mother eats, she goes back upstairs and cleans up the mess. Because the daughter remained calm, so did  her mother.

“A” is for Accept

After assessing, it’s important to accept responsibility for whatever comes next. You are the one with a fully functioning brain. You are the one who has the ability to take control and create a positive outcome. If you expect someone with a brain disease to be responsible and to act as you might wish them to, you’re headed for trouble. I know. I’ve been there, and I never want to go back.

“A” is for Agree

The third in the triple “A” of BANGS is agree. Agree with everything.

“There’s a skunk in the room.” Why yes, there is – AGAIN. How do you suppose he got in here this time?

“You are a horrible, self-centered person who only thinks of herself!” I know Dad, I’m trying to change and I hope to get better with your help (said with sincerity not sarcasm).

The more you agree, the fewer opportunities for conflict will creep in and blow everything to bits. The more you put yourself in their shoes, the better. Is this easy? Nope. It’s mindblowingly difficult. But it works. I’ve done it myself, and I’ve seen others do it as well. It’s a helluva’ lot better than the alternative.

Don’t worry if you miss the mark multiple times like I did initially. Practice makes perfect. Here’s a two-minute clip about the triple “A” in BANGS:

Don’t want to end up in a “shoot-out” with a PWD? Use BANGS.

Remember:

“B” is for breathe.

“A” is for assess, accept, and agree.

“N” is for never, never argue

“G” is for go with their flow, let go of your ego, get over it, get on with it, get down to it

“S” is for say you’re sorry (again, again, and again!)

See also: Teepa Snow demos 10 ways to calm a crisis with a person with dementia

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14 Comments

  1. “The daughter stays calm with shit everywhere. Good so far. But Then we jump from mom sitting on the edge of the bed, daughter suggesting breakfast then scoot quickly and easily without incident into the shower, before eating. MY mom would not go the shower with me no matter how much I breathed, assessed, agreed, or apologized!! 🙂
    Just discovered this site today. A lot of good information here to peruse. The 20 questions why PWD become angry or aggressive totally broke my heart. I must have asked myself those very same questions 100 times two years ago when I had to place Mom in the NH.
    I will never “get over” the pain and guilt of seeing what she has had to endure.

    • Dear anonymous,

      “I will never “get over” the pain and guilt of seeing what she has had to endure.”

      I know exactly what you mean. I’m turning my experience into a force for good by increasing awareness and advocating for change.

      XO X to you

  2. A Caregiver Daughter on

    I think this is great advice. I wish they would teach people in nursing homes to do this! This approach usually keeps my dad on an even keel, even when he is about to blow.

    I am good at implementing this approach with my dad because: 1) I have accepted his Alzheimer’s so I don’t expect things that he can’t deliver; 2) I get immediate, powerful feedback if I convey impatience or frustration, so I don’t.

    With my mom, who is much earlier stage and who doesn’t retaliate when I am upset, I have a terrible time making myself use this approach. For some reason, I cannot accept her cognitive decline, even though I am frustrated that she cannot accept what has happened to my dad. I still want her to understand what I say, to give me back sensible answers, and to not drive me crazy with her fears about everything going wrong. I am like two people with them, a patient, affectionate devoted daughter with one, a frustrated, impatient, exasperated jerk with the other. If she bellowed when I betrayed frustration I could probably improve, but she’s still too understanding to do that 🙁

    I am hoping this formalization of the approach may help me be better with my mom.

    Like Michael, I would like to know what the NGS stands for. (Or should it just be BAAA?)

    • Dear caregiver daughter,

      First, my hats off to you and thanks for everything you are doing for your mom and dad. I know it’s very difficult, but it can also be incredibly rewarding and such a blessing if you can find the joy 🙂

      I also wish they would teach people in nursing homes to behave in ways that help reduce anxiety and aggression instead of increasing it! This will be part of my mission moving forward.

      Congratulations to you for having such acute self-awareness and ability to observe your own behavior – this is huge! Awareness is the first step toward change. I’m delighted that you think the BAAANGS will help and I love your idea of putting all the A’s in the middle 🙂

      Stay in touch, I would love to know more of your story.

      Susan

  3. Hi I’m Rena, Mike gave me the link to your site when I talked to him this afternoon so I thought I would stop by. I didn’t expect to be blown away from the very first read! I love this theory. It’s what I do with mom, but your explanation of it will be so instrumental to the other family members who just don’t get it. I haven’t gotten this far yet. My mom moved with me 3 years ago and as you know it’s a steady slow crawl until the next thing hits. I look forward to getting to know you better. Brilliant post!

    • Hey Rena!

      Mike told me a lot about you too and I can’t wait to visit and follow your blog. Glad you liked the post. Yes, most people don’t get it. Looking forward to swapping stories. Keep up the good work <3

  4. The thing that stuck with me today is how hard this must be for people to do routinely. I struggle with these strategies even in a life unaffected by dementia. I think Accept needs to also be acceptance that as a caregiver you can’t be perfect, and you will miss the mark as you stated, otherwise guilt will consume you.

    • Good point Mike. We make mistakes. I made many. I often wish I could have done better. And yes, I did feel moments of guilt. On the other hand, I have done everything I possibly could for Mom. I truly believe I could not have done anything more. I will be shattered when she leaves, but I will have no regrets. I take comfort in that.

      Equally important, I’m using my mistakes and what I have learned to try to help others have an easier time of it than Mom and I have had. I feel good about that.

      Thanks for your ongoing support and your work with Together in This.

  5. Nice post, with helpful tips. Your comments: “You are the one with a fully functioning brain. You are the one who has the ability to take control and create a positive outcome. If you expect someone with a brain disease to be responsible and to act as you might wish them to, you’re headed for trouble. I know. I’ve been there, and I never want to go back.” Is huge!

    I’m always somewhat shocked when people are surprised by the seemingly wackiness of their conversations with loved ones with Alzheimer’s. They have a brain disease! Of course!

    • Heidi, yes, one might think it’s obvious. But I don’t think we think about the fact that people with dementia have a brain disease. I know I didn’t. I didn’t get it for quite a long time. There is so much talk about plaques and tangles and potential causes and cures and little focus on what the impact of the disease is on the brain and how the changes in the brain result in losses and produce changes in language abilities for example.

      I believe this in turn is because of the highly emotional way in which we view the process of the disease – i.e. “the person I love is disappearing before my eyes with this horrible disease and I’m devastated by the loss,” etc. The long slow train through hell, destination oblivion. The picture is SO unrelentingly bleak.

      Then there’s the emotional rollercoaster of trying to help and support the person with dementia with no understanding of what’s going on and no skills with which to deal with any of it.

      We can do better than this. I know we can. And when we do, everybody — people with the dementia and their care partners — will suffer less. It’s part of my purpose to be instrumental in that transformation.

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